Jill A. Jacobson

Stability of older adults' preferences for life-sustaining medical treatment.

The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment.

Context Changes Choices: A Prospective Study of the Effects of Hospitalization on Life-Sustaining Treatment Preferences

Objective.Policy and law encouraging individuals to document their wishes for life-sustaining medical treatment in advance of serious illness assumes that these wishes are unaffected by changes in health condition. To test this assumption, the authors examine the life-sustaining treatment preferences of a sample of elderly adults prior to, soon after, and several months after a hospitalization experience. Subjects and Methods. As part of the Advance Directives, Values Assessment, and Communication Enhancement (ADVANCE) project, 401 individuals older than age 65 participated in 3 annual interviews. A subsample of 88 individuals who were hospitalized for greater than 48 hours during the course of the study participated in an additional “recovery” interview conducted soon after their release from the hospital (M = 14 days postdischarge). At each interview, subjects indicated their desire to receive 4 life-sustaining medical treatments in 4 serious illness scenarios.Results. Treatment preferences showed a significant “hospitalization dip,” with subjects reporting less desire to receive life-sustaining treatment at the recovery interview than they did at the annual interview conducted prior to hospitalization, but with desire returning to near prehospitalization levels at the annual interview conducted several months after hospitalization. This dip was more pronounced in preferences for cardiopulmonary resuscitation and artificial nutrition and hydration than in preferences for less invasive treatments. Conclusions. Preferences for life-sustaining treatment are dependent on the context in which they are made, and thus individuals may express different treatment preferences when they are healthy than when they are ill. These results challenge a key psychological assumption underlying the use of instructional advance directives in end-of-life decision making.

Religion Replenishes Self-Control

Researchers have proposed that the emergence of religion was a cultural adaptation necessary for promoting self-control. Self-control, in turn, may serve as a psychological pillar supporting a myriad of adaptive psychological and behavioral tendencies. If this proposal is true, then subtle reminders of religious concepts should result in higher levels of self-control. In a series of four experiments, we consistently found that when religious themes were made implicitly salient, people exercised greater self-control, which, in turn, augmented their ability to make decisions in a number of behavioral domains that are theoretically relevant to both major religions and humans’ evolutionary success. Furthermore, when self-control resources were minimized, making it difficult for people to exercise restraint on future unrelated self-control tasks, we found that implicit reminders of religious concepts refueled people’s ability to exercise self-control. Moreover, compared with morality- or death-related concepts, religion had a unique influence on self-control.

Predicting elderly outpatients' life-sustaining treatment preferences over time: The majority rules

Background . This study describes longitudinal changes in the composition and accuracy of modal life-sustaining treatment preferences as predictors of patients’ treatment preferences. Method . Healthy outpatients age 65 and older and their surrogate decision makers recorded preferences for 4 treatments in 9 hypothetical illness scenarios 3 times over a period of 2 years. A statistical prediction model, based on patients’ modal preferences, was created using initial responses and updated 2 years later. Results . When reestimating the model at 2 years, 4 of 27 items in the model created using baseline responses no longer reached the threshold for inclusion, but 5 new items did meet criteria. All modal preference changes reflected a trend toward refusing treatment. Both the original and updated models were more accurate in predicting patients’ preferences than were surrogates making concurrent predictions. Adding covariates (e.g., gender, age, presence of plans for future medical care) did not alter the model’s predictive superiority over surrogates. Conclusions . Models using modal preferences are useful to patients, surrogates, and physicians when trying to accurately discern end-of-life treatment choices, but the models must be updated periodically.

The Effects of Depression on Impression Formation: The Role of Trait and Category Diagnosticity

Two studies examined the impact of trait and category diagnosticity on the social information processing of depressed and non-depressed participants. As suggested by the Weary, Marsh, Gleicher, and Edwards model of the effects of depression on social information processing, it was predicted that depressed participants would be especially sensitive to the diagnosticity of the available information when forming an impression of another person. In Study 1, depressed participants were more sensitive than nondepressed participants to trait diagnosticity when forming an impression. In Study 2, depressed participants were more sensitive than nondepressed participants to both trait and category diagnosticity when forming an impression.

Causal uncertainty and metacognitive inferences about goal attainment

These four studies investigated G. Weary and J. A. Edwards’ (1996) hypothesis that causal uncertainty feelings serve as input to perceivers regarding the adequacy of their causal knowledge and thus determine the amount of processing accorded a given task. Participants worked on a task until they had satisfied an assigned stop rule. In three experiments, high causally uncertain people processed more information under a sufficiency of information rule and less under an enjoyment rule, whereas low causally uncertain people generally did not differentiate between the rules. In the last experiment, low causally uncertain people exhibited a similar pattern to the chronic causally uncertain individuals in the first experiments, but only after their causal uncertainty beliefs and feelings had been primed.

For love or money? What motivates people to know the minds of others?

Mood affects social cognition and “theory of mind”, such that people in a persistent negative mood (i.e., dysphoria) have enhanced abilities at making subtle judgements about others’ mental states. Theorists have argued that this hypersensitivity to subtle social cues may have adaptive significance in terms of solving interpersonal problems and/or minimising social risk. We tested whether increasing the social salience of a theory of mind task would preferentially increase dyspshoric individuals’ performance on the task. Forty-four dysphoric and 51 non-dysphoric undergraduate women participated in a theory of mind decoding task following one of three motivational manipulations: (i) social motivation (ii) monetary motivation, or (iii) no motivation. Social motivation was associated with the greatest accuracy of mental state decoding for the dysphoric group, whereas the non-dysphoric group showed the highest accuracy in the monetary motivation condition. These results suggest that dysphoric individuals may be especially, and preferentially, motivated to understand the mental states of others.

The Role of Causal Uncertainty in the Relationship Between Perceived Parental Dysphoria and Offspring's Own Dysphoria

We proposed that exposure to parental depressive symptomatology as measured by adult children’s retrospective reports would predict children’s own levels of causal uncertainty or doubt in their ability to understand causal relations in the social world. Such social confusion could, in turn, contribute to children’s current depressive symptomatology. Across four studies, as predicted, causal uncertainty partially mediated the relationship between perceived parental dysphoria and offspring’s own current dysphoria. In Study 1c, higher levels of parental attachment moderated the mediational effects of causal uncertainty on the relationship between perceived parental dysphoria and offspring dysphoria, but moderated mediation was not replicated in Study 1d when perceived parental dysphoria was assessed in a separate session. Future research should try to reconcile the inconsistent results for parental attachment and more directly test the intergenerational transmission of dysphoria via causal uncertainty.

The effects of culture and self-construal on responses to threatening health information

Objective: The current studies examined if cultural and self-construal differences in self-enhancement extended to defensive responses to health threats. Design: Responses to fictitious medical diagnoses were compared between Asian-Americans and European-North Americans in Experiment 1 and between Canadians primed with an interdependent versus an independent self-construal in Experiment 3. In Experiment 2, the responses of Chinese and Canadians who were either heavy or light soft drink consumers were assessed after reading an article linking soft drink consumption to insulin resistance. Main outcome measure: The primary-dependent measure reflected participants’ defensiveness about threatening versus nonthreatening health information. Results: In Experiment 1, all participants responded more defensively to an unfavourable than a favourable diagnosis; however, Asian-Americans responded less defensively than did European-North Americans. In Experiment 2, all high soft drink consumers were less convinced by the threatening information than were low soft drink consumers; however, among high consumers, Chinese changed their self-reported consumption levels less than did European-Canadians. In Experiment 3, interdependence-primed participants responded less defensively to an unfavourable diagnosis than did independence-primed participants. Conclusion: Defensive reactions to threatening health information were found consistently; however, self-enhancement was more pronounced in individuals with Western cultural backgrounds or independent self-construals.

Using principal component analysis to reduce complex datasets produced by robotic technology in healthy participants

BackgroundThe KINARM robot produces a granular dataset of participant performance metrics associated with proprioceptive, motor, visuospatial, and executive function. This comprehensive battery includes several behavioral tasks that each generate 9 to 20 metrics of performance. Therefore, the entire battery of tasks generates well over 100 metrics per participant, which can make clinical interpretation challenging. Therefore, we sought to reduce these multivariate data by applying principal component analysis (PCA) to increase interpretability while minimizing information loss.MethodsHealthy right-hand dominant participants were assessed using a bilateral KINARM end-point robot. Subjects (Ns = 101–208) were assessed using 6 behavioral tasks and automated software generated 9 to 20 metrics related to the spatial and temporal aspects of subject performance. Data from these metrics were converted to Z-scores prior to PCA. The number of components was determined from scree plots and parallel analysis, with interpretability considered as a qualitative criterion. Rotation type (orthogonal vs oblique) was decided on a per task basis.ResultsThe KINARM performance data, per task, was substantially reduced (range 67–79%), while still accounting for a large amount of variance (range 70–82%). The number of KINARM parameters reduced to 3 components for 5 out of 6 tasks and to 5 components for the sixth task. Many components were comprised of KINARM parameters with high loadings and only some cross loadings were observed, which demonstrates a strong separation of components.ConclusionsComplex participant data produced by the KINARM robot can be reduced into a small number of interpretable components by using PCA. Future applications of PCA may offer potential insight into specific patterns of sensorimotor impairment among patient populations.